This copy is for your personal non-commercial use only. To order presentation-ready copies of Toronto Star content for distribution to colleagues, clients or customers, or inquire about permissions/licensing, please go to: www.TorontoStarReprints.com

Giving aid with one hand, taking MDs with the other

It sounds like the work of a tourism promotion board in British Columbia: "Snow-capped mountains, fertile valleys, lush green forests and one of the world's most spectacular coastlines."

But the encouragement to come to the province is not meant for backpackers or vacationing families. It is from the website of Health Match BC, a group that seeks to lure a seemingly odd but highly prized demographic – doctors from foreign countries.

Health Match BC did not respond to requests to comment for this article. But they are only one of many groups promoting the benefits of Canadian life to foreign doctors. Indeed, faced with shortages of resources and manpower, provincial health-care systems across the country have long looked overseas to fill vacancies.

These doctors historically came mainly from the U.K., the United States, or other wealthy countries whose own health-care systems, despite flaws, provided world-class care to their citizens.

Now things are different. Today in Canada 10 per cent of the doctors come from South Africa, a country where almost a third of public health posts are vacant and the effects of AIDS, high infant mortality rates, and other scourges devastate lives with appalling regularity.

A report issued earlier this year by the international medical relief organization Doctors Without Borders/Médecins Sans Frontières makes clear just how high the cost of foreign recruitment – or what critics call poaching – has been.

The report details the long lines, lack of drugs, and lack of personnel that are hindering the organization's work in southern Africa. "There are simply not enough nurses, doctors, and medical assistants," a nurse in Malawi says. MSF warns that its inability to expand access to HIV/AIDS treatment threatens to lead to more unnecessary illness and death.

The United Nations estimates that sub-Saharan Africa is in need of 1 million physicians. Some countries are producing more and better doctors, but these improvements also have the perverse effect of making them more attractive to foreign recruiters.

In Ghana, where the exodus of medical personnel has been especially acute, mortality decline stalled in 2003 despite amazing annual real gross domestic product growth of nearly 5 per cent over the previous 10 years.

Back in Canada, so many South African medical professionals have come that some staff quip that Canadian doctors are moving south and South Africans are moving north. It seems every country in the world is a part of this hierarchy of labour migration, recruiting doctors from countries lower in the pyramid as their own move up. In France, for instance, there are more doctors from Benin than there are in Benin.

To be sure, advertisements and solicitations from wealthy countries are only one of many "pull" factors causing this phenomenon. Doctors who go abroad may follow friends or family who have already emigrated, or become interested in working overseas through expatriate networks.

Moreover, as one doctor in Canada pointed out to the CBC earlier this year, doctors have just as much right as anyone else to globalization's promise of free movement of capital and labour. "It's a freedom of choice. Whoever wants to come, I think he should be able to come," said Dr. Syed Peer, a doctor in Newfoundland who was born in India.

Various "push" factors also complicate the picture, including entrenched corruption and violence in home countries.

For its part, the Canadian Medical Association advocates that Canada become self-sufficient in physician supply. "Wealthy Canadians cannot and must not rely on the systematic recruitment of doctors from countries that cannot legitimately afford it," said Dr. Peter Barrett, a former CMA president, in 2005.

But provinces have been slow to act, not least because it is far cheaper to hire a doctor from abroad than to train one locally. A recruitment strategy paper by the Sunrise Health Region in Saskatchewan issued earlier this year briefly mentions "unethical recruitment" concerns, but then goes on to list a 20-point strategy for attracting medical personnel to the region.

The federal Canadian International Development Agency funds medical relief projects throughout the developing world. For example, in July 2006 it gave $500,000 to Médecins Sans Frontières to bolster primary health care in Democratic Republic of Congo.

If not for ethical concerns, concerned citizens might question the utility of government spending money this way while it plays a role in recruiting away the personnel most critical to the success of these kinds of projects.

The Tswana of Botswana have a proverb about pursuing two seemingly contradictory goals at the same time: "Two bulls can't stay in the same kraal." They would fight to the death and destroy the field in the process, so only one can be kept.

If wealthy countries are serious about helping Africa develop, choosing a bull would be a start.

Daniel Morris is in the master's program at the Johns Hopkins University School of Advanced International Studies.

More from The Star & Partners

LOADING

Copyright owned or licensed by Toronto Star Newspapers Limited. All rights reserved. Republication or distribution of this content is expressly prohibited without the prior written consent of Toronto Star Newspapers Limited and/or its licensors. To order copies of Toronto Star articles, please go to: www.TorontoStarReprints.com